@article { author = {Elshahidi, Mohamed and Monir, Nada and Elzhery, Mohamed and Sharaqi, Ahmed and Haedaya, Hames and Awad, Basem and Zaghloul, Khaled}, title = {Epidemiological Characteristics of Traumatic Spinal Cord Injury (TSCI) in the Middle-East and North-Africa (MENA) Region: A Systematic Review and Meta-Analysis}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {75-89}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To systematically search the literature and to summarize current evidence pertaining to the epidemiology of SCI in the MENA region incidence, gender, age, type of the injury and etiology of the injury.Methods: Embase, PubMed, Scopus, Web of Science and EBSCOhost were systematically searched from their dates of inception till July 2017 for English and non-English language articles. Also, regional databases were searched. Data were extracted from eligible articles and pooled under the random effect model using R. References of the included articles were also screened for potentially relevant studies.Results: We identified 29 articles from seven countries in the MENA region (Turkey, Iran, Saudi Arabia, Egypt, Jordan, Kuwait and Qatar). The mean age of the cases at time of injury was 31.32 (95% CI: 28.74-33.91). The random pooled annual incidence of TSCI per million was 23.24 (95% CI: 5.64-49.21). Pooled proportion of male gender was 77% (95% CI 73-80%) of the cases. Complete paraplegia was the most common type of injury. Thoracic level injury predominated. Also, the most commonly affected age group was 20-29 then 30-39. Motor vehicle accidents were found to be the leading cause of injury, then falls, gunshot, violence and sports. Further meta-regression analysis showed no association between age and etiology of the injury.Conclusion: This review shows lack of evidence about SCI in most countries of the MENA region. More epidemiological studies are needed.}, keywords = {Spinal cord injury,Epidemiology,Incidence,Middle-East,North-Africa,Etiology,SCI}, url = {https://beat.sums.ac.ir/article_44431.html}, eprint = {https://beat.sums.ac.ir/article_44431_d7d09bea4de3eeaeb041e2e47294c4f6.pdf} } @article { author = {Azami-Aghdash, Saber and Sadeghi-Bazarghani, Homayoun and Heydari, Mahdiyeh and Rezapour, Ramin and Derakhshani, Naser}, title = {Effectiveness of Interventions for Prevention of Road Traffic Injuries in Iran and Some Methodological Issues: A Systematic Review}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {90-99}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.Methods: Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", “prevention”, and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.Results: Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons’ education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.Conclusion: The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.}, keywords = {effectiveness,Interventions,Prevention,Road traffic injuries,Methodological issues}, url = {https://beat.sums.ac.ir/article_44432.html}, eprint = {https://beat.sums.ac.ir/article_44432_0ddb22121dff9e889ded1d8e63014d01.pdf} } @article { author = {Mashbari, Hassan and Hemdi, Mohannad and Chow, Kevin and Doherty, James and Merlotti, Gary and Salzman, Steven and Singares, Eduardo}, title = {A Randomized Controlled Trial on Intra-Abdominal Irrigation during Emergency Trauma Laparotomy; Time for Yet Another Paradigm Shift}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {100-107}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To determine the optimal volume of abdominal irrigation that will prevent surgical site infections (both deep and superficial), eviscerations and fistula formations; and improve 30-day mortality in trauma patients.Methods: We conducted a three-arm parallel clinical superiority randomized controlled trial comparing different volumes of effluent (5, 10 and 20 liters) used in trauma patients (both blunt and penetrating) age 14 and above undergoing an emergency laparotomy between April 2002 and July 2004 in a busy urban Level 1 trauma center.Results: After randomization, a total of 204 patients were analyzed. All patient groups were comparable with respect to age, gender distribution, admission injury severity score, and mechanism of injury, estimated blood loss and degree of contamination. The mortality rate overall was 1.96% (4/204).No differences were noted with respect to contamination, wound infection, fistula formation, and evisceration. The twenty liter group (Group III) showed a trend toward an increased incidence of deep surgical site infections when compared to the five liter (Group I) (p=0.051) and ten liter (Group II) (p=0.057) groups. This did not however reach statistical significance.Conclusion: The old surgical adage “the solution to pollution is dilution” is not applicable to trauma patients. Our results suggest that using more irrigation, even when large amounts of contamination have occurred, does not reduce post-operative complications or affect mortality; and it may predispose patients to increased incidence of abscess formation.(Trial registration number: ISRCTN66454589).}, keywords = {Intra-abdominal irrigation,Intra-abdominal abscess,Sepsis,Randomized clinical trial,Peritoneal lavage}, url = {https://beat.sums.ac.ir/article_44418.html}, eprint = {https://beat.sums.ac.ir/article_44418_ad6e242a7cddf74c55473ff6381ed3f7.pdf} } @article { author = {Mohammadi, Rahim and Anousheh, Dana and Alaei, Mohammad-Hazhir and Nikpasand, Amin and Rostami, Hawdam and Shahrooz, Rasoul}, title = {Local Xenotransplantation of Bone Marrow Derived Mast Cells (BMMCs) Improves Functional Recovery of Transected Sciatic Nerve in Cat: A Novel Approach in Cell Therapy}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {108-114}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To determine the effects of bone marrow derived mast cells (BMMCs) on functional recovery of transected sciatic nerve in animal model of cat.Method: A 20-mm sciatic nerve defect was bridged using a silicone nerve guide filled with BMMCs in BMMC group. In Sham-surgery group (SHAM), the sciatic nerve was only exposed and manipulated. In control group (SILOCONE) the gap was repaired with a silicone nerve guide and both ends were sealed using sterile Vaseline to avoid leakage and the nerve guide was filled with 100 μL of phosphate-buffered saline alone. In cell treated group ([SILOCONE/BMMC) the nerve guide was filled with 100 μL BMMCs (2× 106 cells/100 μL). The regenerated nerve fibers were studied, biomechanically, histologically and immunohiscochemically 6 months later.Results: Biomechanical studies confirmed faster recovery of regenerated axons in BMMCs transplanted animals compared to control group (p<0.05). Morphometric indices of the regenerated fibers showed that the number and diameter of the myelinated fibers were significantly higher in BMMCs transplanted animals than in control group (p<0.05). In immunohistochemistry, location of reactions to S-100 in BMMCs transplanted animals was clearly more positive than that in control group.Conclusion: BMMCs xenotransplantation could be considered as a readily accessible source of cells that could improve recovery of transected sciatic nerve.}, keywords = {Sciatic nerve,Mast cells,Biomechanical properties,Cats}, url = {https://beat.sums.ac.ir/article_44419.html}, eprint = {https://beat.sums.ac.ir/article_44419_a626612e47a25af29d33e64a80e9cc55.pdf} } @article { author = {Karimipour, Mojtaba and Shojaei Zarghani, Sara and Mohajer Milani, Majid and Soraya, Hamid}, title = {Pre-Treatment with Metformin in Comparison with Post-Treatment Reduces Cerebral Ischemia Reperfusion Induced Injuries in Rats}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {115-121}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To explore the effects of pre versus post ischemic treatment with metformin after global cerebral ischemia in rats.Methods: Male Wister rats underwent forebrain ischemia by bilateral common carotid artery occlusion for 17 min. Metformin (200 mg/kg) or vehicle was given orally by gavage for 7-14 days. Rats were divided into: control, metformin pre-treatment, metformin post-treatment and metformin pre and post continuous treatment groups. Cerebral infarct size, histopathology, myeloperoxidase and serum malondialdehyde were measured 7 days after ischemia.Results: Histopathological analysis showed that metformin pre-treatment significantly decreased leukocyte infiltration, myeloperoxidase activity and also malondialdehyde level. Metformin pre-treatment and metformin post-treatment reduced infarct size compared with the control group, but it was not significant in the pre and post continuous treatment group.Conclusion: Our findings suggest that pre-treatment with metformin in comparison with post-treatment in experimental stroke can reduce the extent of brain damage and is more neuroprotective at least in part by inhibiting oxidative stress and inflammation.}, keywords = {Global cerebral ischemia,Metformin,Oxidative stress,Inflammation}, url = {https://beat.sums.ac.ir/article_44420.html}, eprint = {https://beat.sums.ac.ir/article_44420_dd4db077ba007bf9b5ffecc678fe4686.pdf} } @article { author = {Bazdar, Somaye and Dehghankhalili, Maryam and Yaghmaei, Shekoofeh and Azadegan, Maryam and Pourdavood, Amirhossein and Niakan, Mohammad Hadi and Bananzadeh, Ali Mohammad}, title = {Acute Appendicitis during Pregnancy; Results of a Cohort Study in a Single Iranian Center}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {122-127}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To determine the effects of pregnancy on the presentation, management, surgical and obstetrics outcome of patients with acute appendicitis.Methods: This prospective cohort study was conducted during a 2-year period from 2014 to 2016 in Shahid Faghihi hospital of Shiraz University of Medical Sciences. We enrolled all the pregnant individuals with acute appendicitis who required surgical appendectomy. We also enrolled age-matched controls of non-pregnant women undergoing open appendectomy during the study period. The presentation, clinical and laboratory characteristics, surgical and obstetrics outcomes were determined in both study groups and were further compared between them. In order to determine the determinants of outcome, we also ran a multivariate logistic regression model.Results: Overall we included a total number of 584 patients with presumed appendicitis among whom there were 58 (9.94%) and 526 (90.06%) non-pregnant individuals. The pregnant patients had significantly longer duration of symptoms (p=0.038), lower temperature (p=0.026), longer duration of hospital stay (p=0.026) and higher rate of hospital admission longer than 2 days (p=0.031). The complications of the surgical procedure were comparable between the two study groups except for the pneumonia which was significantly higher in pregnant patient (p=0.041). After adjusting for confounders such as age and ethnicity, pregnancy remained significantly associated with lower temperature (p=0.018), longer symptom duration (p=0.042) and higher rate of pneumonia (p=0.049).Conclusion: Acute appendicitis during the pregnancy was associated with longer duration of symptoms, lower body temperature and higher rate of pneumonia. The pregnancy and neonatal outcomes were comparable to the previously reported data.}, keywords = {Acute Appendicitis,Pregnancy,Open appendectomy,Outcome}, url = {https://beat.sums.ac.ir/article_44421.html}, eprint = {https://beat.sums.ac.ir/article_44421_9ab03209a750cd538c624366ee4e905b.pdf} } @article { author = {Er, Sadettin and Çomçalı, Bülent and Soykurt, Ahmet and Yüksel, Bülent and Tez, Mesut}, title = {Diagnosis of Appendicitis in Patients with a Normal White Blood Cell Count; A Cross-Sectional Study}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {128-132}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To investigate the clinical, imaging and laboratory findings for diagnosis of acute appendicitis (AA) in patients with a normal white blood cell count (WBCC).Methods: This retrospective cross-sectional study was conducted in Ankara Numune Training and Research Hospital, Ankara, Turkey, during a 1-year period. To determine diagnostic factors in AA in patients with normal WBCC, medical records of eligible patients were reviewed for demographic and clinical variables, as well as patient outcome.Results: A total of 105 patients that had undergone appendectomy and were found to have a normal WBCC were included in the study. Of these patients, 53 (50.5%) were men and 52 (49.5%) were women. The mean age of the patients was 34.2±12.3 (min 14, max 78). The negative exploration rate was identified as 19%. In the multivariate analysis, only the diameter of appendix was statistically significant (p=0.002). ROC analysis revealed the cut off appendiceal diameter as 8 mm.                         Conclusion: In patients suspected of AA due to ≥8 mm appendiceal diameter determined by imaging, we recommend surgical treatment even if WBCC and neutrophil count are normal.}, keywords = {Acute Appendicitis,White blood cell count,diagnosis,Appendix diameter}, url = {https://beat.sums.ac.ir/article_44422.html}, eprint = {https://beat.sums.ac.ir/article_44422_7f736d1bd05b7632416fc12089482ce2.pdf} } @article { author = {Rahmanian, Abdolkarim and Derakhshan, Nima and Mohsenian Sisakht, Alireza and Karamzade Ziarati, Najme and Raeisi Shahraki, Hadi and Motamed, Soheil}, title = {Risk Factors for Unfavorable Outcome in Aneurysmal Subarachnoid Hemorrhage Revisited; Odds and Ends}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {133-140}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objectives: To evaluate the odds for unfavorable outcome of each risk factor and a combination of them in patients with aneurysmal subarachnoid hemorrhage (SAH) undergoing surgical clipping in Southern IranMethods: A total of 367 patients who were operated between March 2007 and March 2016 due to aneurysmal SAH were analyzed according to patients’ factors, aneurysm characteristics and intra-operative data. Correlation between outcomes of patients measured by modified Rankin Scale at 6-months with each factor were analyzed. Market Basket analysis was also used to identify the odds of unfavorable outcome for combinations of factors.Results: A total of 367 patients, including 199 females and 168 males with a mean age of 47.27± 11.53 years, who underwent operation between March 2007 and March 2016 due to aneurysmal SAH were analyzed. Unlike gender, higher age was associated with unfavorable outcome. Ischemic heart disease, Duration of operation and amount of bleeding were also found to increase the odds of unfavorable outcome (p=0.01, 0.02, 0.04 respectively). DM, Cigarette smoking and opium addiction as well as the location and multiplicity of aneurysms did not have an adverse effect on outcome. (p≥0.05) Conclusion: Among the numerous risk factors presumed to result in unfavorable outcome in aneurysmal SAH, only older age, duration of operation more than 60 minutes, previous known history of ischemic heart disease, poorer clinical grade and intra-operative bleeding more than 500 mL were found to be significant factors.}, keywords = {Cerebral aneurysm,Risk factors,Market basket analysis,Outcome}, url = {https://beat.sums.ac.ir/article_44423.html}, eprint = {https://beat.sums.ac.ir/article_44423_14f5ddfb5ec63482c248af197c1e7a68.pdf} } @article { author = {Nik, Amir and Sheikh Andalibi, Mohammad Sobhan and Ehsaei, Mohammad Reza and Zarifian, Ahmadreza and Ghayour Karimiani, Ehsan and Bahadoorkhan, Gholamreza}, title = {The Efficacy of Glasgow Coma Scale (GCS) Score and Acute Physiology and Chronic Health Evaluation (APACHE) II for Predicting Hospital Mortality of ICU Patients with Acute Traumatic Brain Injury}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {141-145}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To compare the efficacy and functional outcome of Glasgow Coma Scale (GCS) score with that of Acute Physiology and Chronic Health Evaluation Score II (APACHE II) in patients with multiple trauma admitted to the ICU.Methods: This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II.Results: Positive predictive value (PPV) at the cut-off points was higher in APACHE II (80.6%) compared with GCS (69.2%). However, negative predictive value (NPV) of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic (ROC) curve for sensitivity and specificity of GCS and APACHE II showed no significant difference (0.81±0.04 vs. 0.83±0.04; p=0.278 respectively).Conclusion: Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency.}, keywords = {Head trauma,GCS,APACHE II,Mortality}, url = {https://beat.sums.ac.ir/article_44424.html}, eprint = {https://beat.sums.ac.ir/article_44424_f0f8b66b5d38f6104b5c65a84c0525c1.pdf} } @article { author = {Sadeghi-Bazargani, Homayoun and Samadirad, Bahram and Shahedifar, Nasrin and Golestani, Mina}, title = {Epidemiology of Road Traffic Injury Fatalities among Car Users; A Study Based on Forensic Medicine Data in East Azerbaijan of Iran}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {146-154}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied.              Results: Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses.Conclusion: Decreasing the car users’ fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.}, keywords = {Car Users,Injury,Mortality,Road traffic accidents,Epidemiology}, url = {https://beat.sums.ac.ir/article_44425.html}, eprint = {https://beat.sums.ac.ir/article_44425_6ecb5f16707770e61fd36d55e8c5aa6c.pdf} } @article { author = {Rasouli, Abbas and Hosseini, Seyed Mojtaba and Bahadori, Mohammad Karim and Ravangard, Ramin}, title = {Characteristics of Occupational Injuries in a Pharmaceutical Company in Iran}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {155-161}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process (AHP).Methods: This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method (N=n=130 employees). A data collection form was designed for identifying the hazards using the Nominal Group Technique (NGT) method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0.Results: The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" (W=0.253) and “being exposed to radiation” (W=0.022) in the laboratory unit, "skin injuries" (W=0.205) and “bending and straightening for a long time” (W= 0.032) in the production unit, "falling down" (W=0.271) and “standing and sitting for a long time “ (W=0.037) in the installations and facilities unit, and "hand joint failure" (W=0.295) and “working in a low-light environment” (W=0.092) in the administrative unit.Conclusion: The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company’s units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential.}, keywords = {Occupational hazards,Safety,Pharmaceutical company,Analytical Hierarchy Process (AHP),Iran}, url = {https://beat.sums.ac.ir/article_44426.html}, eprint = {https://beat.sums.ac.ir/article_44426_d86627e88c588e34ef5dfd0087e6ba1f.pdf} } @article { author = {Pekez-Pavlisko, Tanja and Racic, Maja and Jurišić, Drinka}, title = {A Questionnaire Study on the Attitudes and Previous Experience of Croatian Family Physicians toward their Preparedness for Disaster Management}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {162-168}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Objective: To explore family physicians’ attitudes, previous experience and self-assessed preparedness to respond or to assist in mass casualty incidents in Croatia.Methods: The cross-sectional survey was carried out during January 2017. Study participants were recruited through a Facebook group that brings together family physicians from Croatia. They were asked to complete the questionnaire, which was distributed via google.docs. Knowledge and attitudes toward disaster preparedness were evaluated by 18 questions. Analysis of variance, Student t test and Kruskal-Wallis test t were used for statistical analysis.Results:  Risk awareness of disasters was high among respondents (M = 4.89, SD=0.450). Only 16.4 of respondents have participated in the management of disaster at the scene. The majority (73.8%) of physicians have not been participating in any educational activity dealing with disaster over the past two years. Family physicians believed they are not well prepared to participate in national (M = 3.02, SD=0.856) and local community emergency response system for disaster (M = 3.16, SD=1.119). Male physicians scored higher preparedness to participate in national emergency response system for disaster (p=0.012), to carry out accepted triage principles used in the disaster situation (p=0.003) and recognize differences in health assessments indicating potential exposure to specific agents (p=0,001) compared to their female colleagues.Conclusion: Croatian primary healthcare system attracts many young physicians, who can be an important part of disaster and emergency management. However, the lack of experience despite a high motivation indicates a need for inclusion of disaster medicine training during undergraduate studies and annual educational activities.}, keywords = {Family physicians,Disaster,Attitude,Mass casualty,Knowledge,Disaster response}, url = {https://beat.sums.ac.ir/article_44427.html}, eprint = {https://beat.sums.ac.ir/article_44427_7b9ffaae3b6284d6eecc875cbad05daa.pdf} } @article { author = {Ozsoy, Mustafa and Ersen, Ogun and Ozsoy, Zehra and Yilmaz, Sezgin and Arıkan, Yüksel}, title = {Avulsion of Ampulla of Vater Secondary to a Blunt Abdominal Injury Treated with Pancreatoduodenectomy; A Case Report and Literature Review}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {169-173}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {The incidence of complex hepatobiliary injury secondary to blunt abdominal injuries varies between 3.4 and 5%. A 25-year old male patient underwent an urgent operation due to a motorcycle accident. During intraabdominal exploration, Grade 4 laceration was detected at the liver and bleeding was controlled through primary repair. In the postoperative seventh day, he was referred due to 1500 cc bile leakage from the drainage tube. During the operation, an extensive Kocher maneuver was done and the second part of duodenum was observed to be exposed to total avulsion from the head of the pancreas. Pancreatoduodenectomy was planned due to presence of ischemic changes in the second part of duodenum. In the postoperative follow-up, the abdomen was closed with a controlled abdominal closure procedure. The clinical findings of biliary tract injuries secondary to blunt abdominal injuries often manifest themselves late and early diagnosis is possible only with suspicion.}, keywords = {Ampulla vater,Blunt abdominal trauma,Duodenal trauma,Avulsion}, url = {https://beat.sums.ac.ir/article_44428.html}, eprint = {https://beat.sums.ac.ir/article_44428_bd8e4956fa9a59c7431e0925e1d256f0.pdf} } @article { author = {Hoz, Samer and Baban, Khatab and Sabah, Mohamad and Aktham, Awfa and Narvaez-Rojas, Alexis and Moscote-Salazar, Luis}, title = {Delayed Progressive Intraparenchymal Tension Pneumocephalus after Craniotomy for Recurrent Pituitary Macroadenoma: A Case Report}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {174-177}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Pneumocephalus is defined as the presence of air in the intracranial cavity. In most cases, its evolution is asymptomatic and benign. Pneumocephalus post-surgery is a frequent complication of cranial surgery. We herein report delayed tension pneumocephalus after craniotomy for pituitary macroadenoma. A 73-year-old man with recurrent pituitary macroadenoma underwent subtotal resection via subfrontal approach. The postoperative course was uneventful and the patients regained his normal daily living activities. Two months after the surgery the patients developed decreased level of consciousness and was diagnosed to suffer from tension pneumocephalus. Another craniotomy was performed and the dural defect at the base was repair with secondary graft and bone wax. The patient improved neurologically and had no pneumocephalus. The follow-up revealed good condition and outcome. In conclusion, tension pneumocephalus can occur at any time after craniotomy and post-surgical deterioration after resection of a giant pituitary tumor should be immediately assessed. There is not enough evidence to correlated tumor size with rates of pneumocephalus in this particular report, but further cases may need to be studied to come to a conclusion.}, keywords = {Tension pneumocephalus,Craniotomy,Pituitary adenoma}, url = {https://beat.sums.ac.ir/article_44429.html}, eprint = {https://beat.sums.ac.ir/article_44429_1639b5725c1477157f2816cf4312dd43.pdf} } @article { author = {Eid, Joseph and Cronin, Brian and Seman, Susan}, title = {An Unforeseeable Complication; Posterior Ischemic Optic Neuropathy after Penetrating Injury to the Heart}, journal = {Bulletin of Emergency And Trauma}, volume = {6}, number = {Issue 2}, pages = {178-180}, year = {2018}, publisher = {Shiraz University of Medical Sciences}, issn = {2322-2522}, eissn = {2322-3960}, doi = {}, abstract = {Trauma surgeons are currently encountering unusual adverse events after traumatic injuries. Ischemic optic neuropathy is a rare complication that may occur in trauma and burn patients that present in extremis and require massive resuscitation. A 29-year-old male patient sustains a penetrating injury to the heart that required primary repair. He remained hemodynamically stable and required a limited amount of resuscitative fluids and products. Postoperatively, the patient develops acute painless bilateral loss of vision. These findings were consistent with posterior ischemic optic neuropathy. Ischemic optic neuropathy are uncommon entities that arise in trauma patients who require massive resuscitation. Given the limited treatment options, early diagnosis is key in limiting the hemodynamic insult to the optic nerve. }, keywords = {Ischemic optic neuropathy,Posterior ischemic optic neuropathy penetrating wound,Postoperative Complication}, url = {https://beat.sums.ac.ir/article_44430.html}, eprint = {https://beat.sums.ac.ir/article_44430_66327ae05ccffb023b22bf0f8933c8fc.pdf} }